Sajeev Jithin K, Kalman Jonathan M, Dewey Helen, Cooke Jennifer C, Teh Andrew W
Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia.
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
JACC Clin Electrophysiol. 2020 Mar;6(3):251-261. doi: 10.1016/j.jacep.2019.12.013.
Atrial fibrillation (AF) is well-recognized in the pathophysiology of left atrial thrombogenesis and resultant cardioembolic stroke. Subclinical AF is believed to account for a significant proportion of embolic stroke. However, recent randomized control trials failed to demonstrate a significant benefit for oral anticoagulation, in an unselected population with embolic stroke of undetermined source. This has reinvigorated the focus on finding robust markers to identify patients at risk of cardioembolic stroke. Several nonfibrillatory atrial electrical markers, along with structural and biochemical abnormalities, have been associated with ischemic stroke, independently of AF. An increasingly complex relationship exists among vascular risk factors, atrial remodeling, and thrombogenesis. Identifying robust markers of an underlying atrial myopathy may allow for early identification of patients at risk for cardioembolic stroke. This review outlines the inconsistencies in the evidence for AF as the prerequisite for left atrial thrombogenesis and embolic stroke. It will highlight the current evidence and controversies for adverse atrial remodeling, independent from rhythm, as a plausible mechanism for left atrial thrombogenesis and ischemic stroke.
心房颤动（AF）在左心房血栓形成及由此导致的心源性栓塞性卒中的病理生理学中已得到充分认识。亚临床房颤被认为是栓塞性卒中的重要组成部分。然而，最近的随机对照试验未能在未选定的不明来源栓塞性卒中患者群体中证明口服抗凝治疗有显著益处。这再次激发了寻找可靠标志物以识别心源性栓塞性卒中风险患者的关注。一些非颤动性心房电标志物，连同结构和生化异常，已被发现与缺血性卒中相关，且独立于房颤。血管危险因素、心房重构和血栓形成之间的关系日益复杂。识别潜在心房肌病的可靠标志物可能有助于早期识别心源性栓塞性卒中风险患者。本综述概述了将房颤作为左心房血栓形成和栓塞性卒中前提条件的证据中的不一致之处。它将强调目前关于独立于节律的不良心房重构作为左心房血栓形成和缺血性卒中可能机制的证据及争议。
